Peer-level multiple source feedback for fitness to practice.

We assigned a group of 8 medical students (n 1⁄4 141) to each PTSP. Students were given specific roles: taking a brief history; performing a symptom-focused physical examination, or observing and providing feedback. The session began with 2 concurrent shoulder cases in which a PTSP guided a group of medical students in interviewing and physical examination skills. After 45 minutes of data-gathering and peer-topeer feedback, 2 groups with different cases combined to present their findings for 2 faculty cofacilitators representing anatomy and clinical medicine. Specific students were assigned to present the case history in front of the group; others demonstrated physical examination findings. Anatomy faculty members then highlighted the underlying anatomical principles and surface anatomy for each case. Finally, doctor-facilitators offered feedback on the students’ oral presentations and physical examination demonstrations, elicited a differential diagnosis from the group, and gave therapeutic suggestions. The process was then repeated with 2 cases of knee pain. Evaluation of results and impact We elicited feedback from all levels of workshop participants in several domains using a Likert scale of 1)5 (1 1⁄4 strongly disagree, 5 1⁄4 strongly agree). Medical students (n 1⁄4 137; 97%) appreciated the expertise of the PTSP (4Æ8), enjoyed learning from the PTSP (4Æ7), improved their approach to musculoskeletal problems (4Æ5), and felt able to apply knowledge of underlying anatomy (4Æ4). The PTSPs (n 1⁄4 16; 100%) felt that their expertise helped medical students (4Æ4) and felt that the exercise improved their teaching about shoulder and knee problems (4Æ3). Faculty members (n 1⁄4 13; 81%) found that it was valuable for PTSPs to teach medical students (4Æ8) and that the exercise helped medical students apply anatomy to clinical cases (4Æ6). Students would have liked more time for practice. Some groups spontaneously held brief sessions that allowed the PTSPs to describe their training and to discover ways in which all could work best as a team. Overall, this multidisciplinary workshop transparently showed medical students the bridge between basic anatomy content and physical examination skills. The process of the workshop emphasised learner-centred learning and simulated data gathering and case presentation to supervising faculty in a clinical situation. Finally, the exercise fostered mutual respect and a collaborative spirit among members of 3 separate disciplines – anatomy, physical therapy and medicine. Correspondence: Dr Calvin L Chou, Department of Medicine, Veterans Affairs Medical Center, 4150 Clement Street (111), San Francisco, California 94121, USA. Tel: 00 1 415 221 4810 ext. 2740; Fax: 00 1 415 750 6982; E-mail: [email protected]